You Can’t All Come at Once: Improving Chemotherapy Scheduling

In this video Lindsey Radcliff, BSN, RN, of the James Cancer Hospital in Ohio, discusses steps her institution took to improve chemotherapy scheduling in an attempt to increase the number of patients scheduled and reduce patient wait times.

Please note: Due to technical difficulties with the audio during the shooting of this video, we’ve provided a transcript of the discussion below.

My name is Lindsey Radcliff, and I work for the James at the Stefanie Spielman Breast Center, and I’m a chemo infusion nurse. We found a problem that we were seeing about 50 patients between 10:00 a.m. and 2:00 p.m., and that was the majority of our patients. The bulk of our patients were being seen between those times.

Nurses felt that patient safety was being jeopardized at times and found some inefficiencies in the way we were scheduling our patients. Providers were getting upset with us having to say no to add-ons all the time, because either it was not safe or we just didn’t have chair space for patients at the time they wanted to send them back.

So we created a multidisciplinary team that consisted of nurses, providers, office associates-who are the schedulers-physicians, and nurse practitioners. We created a set of guidelines of how these patients could be scheduled. We started at 11:00 a.m. Anything that was 6 hours or longer had to be scheduled by 11:00 a.m. By 12:00 p.m. it had to be 5 hour treatments, by 1:00 p.m. it had to be 4 hour treatments, and so on.

Then we polled our patients to see if they would rather have earlier morning appointment times or evening appointment times. Most of them preferred morning times so we increased the number of treatments we can take in the morning slots. So at 7:30 a.m. we can take three patients where we used to only take one. And by 8:00 a.m. we can take four patients where we used to only take two, and so on. We increased our nurse staffing in the morning to accommodate these patients, and by 9:00 a.m. we’re fully staffed.

Any patient that saw a provider still had their same-day chemo appointment, they were scheduled between 9:00 a.m. and 2:00 p.m. After 2:00 p.m. we resumed taking outside patients who are coming in for an infusion that didn’t see the providers. Our cut-off time is 4:30 p.m. simply because our lab stops at 4:30 p.m., so we can’t get any labs after that time.

We sent these guidelines out to our providers and our scheduling staff, and they pretty much stick to it because the results show that we can pretty much accommodate anyone that they want to add on.

Our patient satisfaction scores are in the 95^th percentile, and they’re verbatim saying on their patient satisfaction surveys that their wait times decreased. That’s because most of them wanted to come by 11:00 a.m., when it would take them 2 hours to get a 30-minute infusion, and now they’ll come at 2:30 p.m. and are there for 45 minutes. They really like that. Also in our National Database of Nursing Quality Indicators (NDNQI) survey for nurses-our autonomy score increased based upon our 2013 score to our 2015 score.

Overall our wait times decreased for patients and that was huge. Our providers stay committed to this because they want their add-ons to happen at the Breast Center, and we’re able to do that now. They feel like patient safety is Number 1, and we’re still able to meet those needs with the time scheduling that we set up here.